Prospective Study of Open Book Technique of Endoscopic Septoplasty in Deviated Nasal Septum Patients

Background: Deviated nasal septum is a common anatomical abnormality and an important cause of nasal obstruction. Conventional septoplasty performed under headlight illumination may have limitations in visualization, particularly in patients with posterior septal deviations and sharp septal spurs. Endoscopic septoplasty provides improved illumination, magnification and direct visualization of the septal deformity, allowing more precise and targeted correction with limited mucoperichondrial dissection. The open-book technique is an adjunctive endoscopic approach that provides wider exposure of the deviated septal segment and facilitates management of prominent or sharp septal spurs that may be difficult to address by conventional techniques. Material and Methods: The present prospective study was conducted in the Department of ENT & Head Neck Surgery, Kalpana Government Medical College, Karnal, Haryana, over a period from 2019 to 2026. Due to non availability of elective patients during COVID 19 pandemics the study was extended. A total of 50 patients aged 18–50 years presenting with symptomatic nasal obstruction associated with deviated nasal septum were included in the study. Patients who underwent endoscopic septoplasty as part of endoscopic sinus surgery were excluded. Results: In this study there were 29 male patients (58%) and 21 female patients (42%). Male : Female ratio was 1.4:1. Majority of patients were in age group of 20-30 years. Deviation of nasal septum towards left side was seen in 54% (27 cases), bilateral in 12% (6 cases) and towards right side in 34% (17 cases). Predominant symptom was nasal obstruction (100%) and facial pain/pressure (10%). 13 patient (26%) had mainly cartilaginous deviation while 21 (42%) had cartilaginous and bony deviation and 16 (32%) had cartilage, bony and maxillary crest deviation. Complications with this procedure were minimal due to direct visualization. There were 2 patients with post op synechiae that were released post operative. There were 4 patients who had a 3 mm tear & 2 patients with 2 mm minimal tear on the contralateral mucoperichondrium during the surgery but healed well post operatively when reviewed at 3 month. Conclusion: Open book approach for endoscopic septoplasty provides a direct visualization of the nasal cavity with endoscope particularly the posterior sharp septal spur. Endoscopic open-book septoplasty is an adjunct technique to address the sharp septal spur with good outcomes. Hence, incorporation of this technique as a part of the routine endoscopic septoplasty is beneficial for our patients.

Keywords: Deviated nasal septum, Endoscopic septoplasty, Open-book technique, Septal spur.